Fascioliasis Workup

  • Author: Robert W Tolan Jr, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Apr 10, 2012
 

Laboratory Studies

CBC count

Leukocytosis may occur. Severe anemia may occur, especially in children. Eosinophilia occurs in 95% of acute stage infections. Eosinophilia may wax and wane during the chronic stage of infection. Among Egyptian children with acute fascioliasis, 14-82% had peripheral eosinophilia.[9]

Erythrocyte sedimentation rate

About one half of affected patients have an elevated erythrocyte sedimentation rate.

Serology

Serologic modalities include complement fixation, immunofluorescence, indirect hemagglutination, counterimmunoelectrophoresis, and enzyme-linked immunosorbent assay (ELISA).[10]

The Falcon screening test-ELISA is the most reliable diagnostic study and is the test of choice because of its routine availability, cost, sensitivity, and specificity.

A serum ELISA test result may become positive months before stool examination for ova because flukes do not produce eggs until the chronic stage (ie, 4 mo after infection [range, 3-18 mo]).

Polymerase chain reaction (PCR) assays

PCR assays have been developed for the rapid diagnosis of fascioliasis.[11]

Immunoglobulin levels

These may be elevated, particularly immunoglobulins G and E.

Liver function tests

Elevated levels of gamma-glutamyl transpeptidase, alkaline phosphatase, and bilirubin may suggest cholestatic liver injury.

Although rare, elevated transaminase levels suggest hepatocellular injury.

Stool examination for ova and parasites

The small number of eggs in stool requires multiple specimens. The eggs measure 130-150 X 60-90 μm and can be confused with Fasciolopsis buski eggs. The FLOTAC technique may have superior sensitivity to standard sedimentation stool examinations.[12]

ELISA for Fasciola coproantigens may be performed on stool specimens.[13]

Flukes that measure 30 X 15 mm almost never appear in stool; the rare exceptions follow successful treatment.

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Imaging Studies

Chest radiography

In patients with pulmonary symptoms, parenchymal infiltrates are rarely visible. A right-sided pleural effusion is also rare.

Ultrasonography

Ultrasonography may reveal hypodense/hypoechoic lesions in the liver that correspond to the burrow tracks of the larvae. Ultrasonography may reveal the adult fluke in a bile duct or the gallbladder. Ultrasonography rarely reveals scant ascites.

CT scanning

CT scanning may reveal multiple lesions that measure 1-10 mm or tunnels in the liver parenchyma.[14, 15] A radiating pattern of tunnels is diagnostic. CT scanning may also reveal an adult fluke in a bile duct or the gallbladder.

MRI

MRI may suggest granulomata of the liver parenchyma and may provide findings similar to CT scanning.

Cholangiography

This may reveal a fluke in the biliary tree.

US-guided gallbladder aspiration

This can reveal eggs in the bile, even when stool examination test results are negative.

Technetium-99 scanning

This imaging study reveals multiple intrahepatic defects in approximately 50% of cases.

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Other Tests

Bone marrow aspiration, performed only as part of the diagnostic evaluation for other conditions, can reveal increased bone marrow eosinophils.

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Procedures

Duodenal aspiration may reveal eggs.

Liver biopsy findings include the following:

  • Liver biopsy can reveal microabscesses and tunnels of parenchymal necrosis, surrounded by inflammatory infiltrates containing abundant eosinophils.
  • Older lesions may be fibrotic.

Laparoscopy often reveals multiple gray-white and yellow nodules, 2-20 mm in diameter, and short vermiform cords on the liver surface. Rarely, these nodules may occur throughout the peritoneal cavity and intestine wall.

Exploratory laparotomy may reveal identical findings as laparoscopy; flukes are often present in the bile duct or gallbladder.

Upper GI endoscopy is associated with the following:

  • Endoscopy can reveal a filling defect in the bile duct.
  • Endoscopic removal of the fluke is possible.
  • Administration of intravenous cholecystokinin can promote egg release, which can be sampled endoscopically for diagnosis.

Thoracentesis for pleural effusion may reveal increased eosinophils in pleural fluid.

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Histologic Findings

Flukes can be found during autopsy or in surgical specimens. Multiple subcapsular cavities (5-10 mm in diameter) may be present, filled with necrotic material from which necrotic tracks radiate and surrounded by inflammatory infiltrates that contain large numbers of eosinophils.

Fibrosis may characterize older lesions. Tissues taken from ectopic sites of larval migration may demonstrate granulomatous nodules or small abscesses.

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Contributor Information and Disclosures
Author

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Specialty Editor Board

Glenn Fennelly, MD, MPH  Director, Division of Infectious Diseases, Lewis M Fraad Department of Pediatrics, Jacobi Medical Center; Clinical Associate Professor of Pediatrics, Albert Einstein College of Medicine

Glenn Fennelly, MD, MPH is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Martin Weisse, MD  Program Director, Associate Professor, Department of Pediatrics, West Virginia University

Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Daniel Rauch, MD, FAAP  Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine

Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine

Disclosure: Baxter Honoraria Consulting

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

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Life cycle of Fasciola hepatica.
 
 
 
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